| NPI | 1376948208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DE 0000703) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC007600) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2015-10-02 |