| NPI | 1790867083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC003965) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2025-10-15 |