| NPI | 1760960512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC010615) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2023-09-19 |