| NPI | 1902645328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC01032800) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC015613) |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2025-05-07 |