| NPI | 1417581018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA CW023384) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: PA SW137023) | |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2023-09-12 |