| NPI | 1306961503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC004200) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA CW015535) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |