| NPI | 1538040167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW142467) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA SW142467) |
| 106H00000X Marriage & Family Therapist (Licence: PA SW142467) | |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2026-04-16 |