| NPI | 1528307923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 71369) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC006745) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 8233) | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2021-11-25 |