| NPI | 1992253348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC009176) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C8124) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2026-09-04 |