| NPI | 1982219770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA PC012648) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA 012648) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2021-10-02 |