| NPI | 1427422534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC013105) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CO LPC.0012769) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2022-04-04 |