| NPI | 1982938148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC012851) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI 00436) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2020-12-04 |