| NPI | 1992296628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA PC010069) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA PC010069) |
| 101YM0800X Counselor, Mental Health (Licence: PA PC010069) | |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2018-05-29 |