| NPI | 1043752744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 2298) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC009282) |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2026-02-05 |