| NPI | 1538222534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC001988) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 011479-01) |
| 101YP2500X Counselor Professional (Licence: OH E.1800770-SUPV) | |
| 103TC1900X Psychologist Counseling (Licence: PA PC001988) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2021-11-08 |