| NPI | 1477040673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC011392) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 7034-125) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2023-03-06 |