| NPI | 1154781862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC008745) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA PC008745) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA PC008745) | |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2016-02-24 |