| NPI | 1801075551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC004532) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA PC004532) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2023-03-02 |