| NPI | 1295876910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: PA PC004404) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: VA 0701005594) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2022-07-21 |