| NPI | 1679865976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC005862) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 13869) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2025-10-06 |