| NPI | 1750097234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC016268) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2024-10-06 |