| NPI | 1609474212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC012863) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 101Y00000X Counselor | |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2024-02-02 |