| NPI | 1518587864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PCO11877) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PCO11877) |
| 101YM0800X Counselor Mental Health (Licence: PA PCO11877) | |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2020-08-18 |