| NPI | 1750004990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC010885) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC0180885) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2023-11-02 |