| NPI | 1326820267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC016152) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL TPMC4876) |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2025-01-17 |