| NPI | 1437128782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC003168) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA 4641) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2020-07-14 |