| NPI | 1558658088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC005853) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH18719) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2021-05-23 |