| NPI | 1285728642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA PC003641) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC003641) |
| 101YP2500X Counselor, Professional (Licence: PA PC003641) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-06-14 |