NPI | 1467554147 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: PA PC001261) |
Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC001261) |
101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA PC001261) | |
101YP2500X Counselor Professional (Licence: PA PC001261) | |
Enumeration Date | 2006-09-02 |
Last Update Date | 2019-05-30 |