| NPI | 1992179022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC008148) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC008148) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2024-07-17 |