| NPI | 1891842407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00385700) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC008206) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2017-12-13 |