| NPI | 1104662238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA APC001068) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA ACP001068) |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2025-10-09 |