| NPI | 1477614899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC000299) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: PA MF000121) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2025-05-09 |