| NPI | 1275674558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC004792) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC-11999) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2023-12-03 |