| NPI | 1003973306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA 003169) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: PA PC003169) | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2024-06-02 |