| NPI | 1720213200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH13071) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC004777) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2015-05-28 |