| NPI | 1831475888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC005926) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701005875) |
| Enumeration Date | 2011-10-21 |
| Last Update Date | 2018-05-08 |