| NPI | 1629442918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC003955) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC003955) |
| Enumeration Date | 2015-11-24 |
| Last Update Date | 2016-09-02 |