| NPI | 1285440347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA 23-2835448) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA 23-2707806) |
| Enumeration Date | 2024-12-04 |
| Last Update Date | 2024-12-04 |