| NPI | 1063453496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC000262) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC000262) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2010-07-12 |