| NPI | 1457076333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: PA PC016645) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC016645) |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2024-04-18 |