| NPI | 1578508438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA PC004115) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC004115) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2007-07-08 |