| NPI | 1003106485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC014935) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.007830) |
| 101YP2500X Counselor, Professional (Licence: PA PC014935) | |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2024-05-01 |