| NPI | 1053863977 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC7191) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC009317) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2018-03-17 |