| NPI | 1760400048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: PA PC001492) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 007338) |
| 101YP2500X Counselor Professional (Licence: PA PC004192) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-01-30 |