| NPI | 1942405345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA PC004578) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA pc004578) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2021-02-25 |