| NPI | 1013140631 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC005234) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC005234) |
| 183500000X Pharmacist (Licence: PA RP034624L) | |
| Enumeration Date | 2009-08-30 |
| Last Update Date | 2009-08-30 |