| NPI | 1427314244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC006296) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC3524) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2022-07-21 |