| NPI | 1407280605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC005179) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA PC005179) |
| 101YM0800X Counselor Mental Health (Licence: PA PC005179) | |
| Enumeration Date | 2013-08-25 |
| Last Update Date | 2018-11-07 |