| NPI | 1932503125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC009523) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2014-10-16 |
| Last Update Date | 2022-07-21 |