| NPI | 1497074637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC006282) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA PC006282) |
| 101YP2500X Counselor, Professional (Licence: PA PC006282) | |
| 101Y00000X Counselor (Licence: PA PC006282) | |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2015-09-18 |