| NPI | 1558695080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC005289) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00402400) |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2010-09-27 |