| NPI | 1003083635 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC005413) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WV 2037) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2012-04-20 |