| NPI | 1013258763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC00006787) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA PC00006787) |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2016-08-01 |