| NPI | 1457848012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC012094) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701007262) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2024-03-29 |