| NPI | 1063163921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA CW022916) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA SW136505) |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-12-05 |