| NPI | 1730845793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: PA PC013968) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: DE PC-0011193) |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2023-08-08 |