| NPI | 1174675680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC001178) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC001178) |
| 106H00000X Marriage & Family Therapist (Licence: PA PC001178) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2011-04-15 |