| NPI | 1578078333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC001095) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2017-12-02 |
| Last Update Date | 2019-10-24 |