| NPI | 1386392322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC002687) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 76061) |
| Enumeration Date | 2022-03-17 |
| Last Update Date | 2025-03-04 |