| NPI | 1972883221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC006073) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701005079) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2022-10-14 |