| NPI | 1437456332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 17932) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC005343) |
| Enumeration Date | 2011-02-12 |
| Last Update Date | 2024-05-31 |