| NPI | 1306479910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC010138) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC010138) |
| 101YP2500X Counselor, Professional (Licence: DE PC-0000979) | |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2024-03-28 |