| NPI | 1215554936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC12472) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC012472) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2025-08-20 |