| NPI | 1811344609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC015731) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0022348) |
| 101YP2500X Counselor, Professional (Licence: DE MI-0000257) | |
| Enumeration Date | 2016-05-21 |
| Last Update Date | 2026-04-27 |