| NPI | 1851954093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA PC011223) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DE 23233) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2025-09-29 |