| NPI | 1487209813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA pc015874) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PA015874) |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2024-10-20 |