| NPI | 1548457914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV CP0046) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC003673) |
| 101YP2500X Counselor, Professional (Licence: PA PC003673) | |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2011-04-28 |