| NPI | 1992470629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC012823) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC012823) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA PC012823) | |
| 101YM0800X Counselor Mental Health (Licence: PA PC012823) | |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2021-08-13 |