| NPI | 1376694588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC006650) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 0066752) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2013-05-01 |