| NPI | 1871969543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC008386) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA PC008386) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2025-07-08 |