| NPI | 1558467811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP1600X Counselor, Pastoral (Licence: PA PC001954) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC001954) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA PC001954) | |
| 101YM0800X Counselor, Mental Health (Licence: PA PC001954) | |
| 101YP2500X Counselor, Professional (Licence: PA PC001954) | |
| 103T00000X Psychologist (Licence: OK 01360) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2008-02-28 |