| NPI | 1093588725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 289905) |
| 101YP2500X Counselor, Professional (Licence: PA PC017814P) | |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2026-03-11 |