| NPI | 1205615234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC016908) |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2025-11-19 |