| NPI | 1477607026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: PA MF000540) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: NJ 2000366) |
| 101YP2500X Counselor, Professional (Licence: NJ 37FI00162900) | |
| 101YP2500X Counselor, Professional (Licence: PA MF000540) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2011-06-18 |