| NPI | 1306390455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: PA PC008948) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC008948) |
| 106H00000X Marriage & Family Therapist (Licence: PA PC008948) | |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2022-07-21 |