| NPI | 1063718195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC006003) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701004999) |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2012-09-06 |