| NPI | 1669548160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC003529) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 18881) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2024-09-13 |