| NPI | 1528399789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW000123L) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NJ 37F100102700) |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2010-01-27 |