| NPI | 1669061362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC015112) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA 101YM0800X) |
| Enumeration Date | 2021-01-16 |
| Last Update Date | 2023-01-10 |