| NPI | 1124464441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC017052) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: PA MF000917) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2024-10-14 |