| NPI | 1578128781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC12475) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC014222) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2022-03-11 |