| NPI | 1609330638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA PC010947) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC010947) |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-01-23 |