| NPI | 1992221048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC013133) |
| Additional Taxonomies | 246ZA2600X Specialist/Technologist, Other, Art, Medical (Licence: NY 000218-1) |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2021-06-08 |