| NPI | 1790121960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC011294) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2019-12-02 |