Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003005851 |
---|---|
Provider Name | Mr. Gregory Scott Wentz |
First Address | Lebanon, PA 17046 |
Second Address | York, PA 17401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2007 |
Last Update Date | 17/10/2007 |