| NPI | 1568990679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC011553) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: PA PC011553) | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2022-07-21 |