| NPI | 1770313306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC017853) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA APC000269) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2025-01-07 |