| NPI | 1700105665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA CW016655) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA CW016655) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2010-05-18 |