| NPI | 1982272340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC016978) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2025-08-27 |