NPI | 1053507582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW001344L) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: PA MF000326) |
Enumeration Date | 2007-09-18 |
Last Update Date | 2007-09-21 |