| NPI | 1811075112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00142500) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: NJ 37RC00157700) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2012-11-13 |