| NPI | 1720765035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA BH006395) |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 171M00000X Case Manager/Care Coordinator | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2023-06-28 |