NPI | 1356882757 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC009465) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 9574) |
Enumeration Date | 2017-03-17 |
Last Update Date | 2017-03-17 |