| NPI | 1629749833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC013441) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2021-09-28 |