| NPI | 1649596016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC001645) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA PC001645) |
| Enumeration Date | 2010-04-10 |
| Last Update Date | 2010-07-29 |