| NPI | 1548587728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: PA PS-005244-L) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP1600X Counselor Pastoral | |
| 103TF0200X Psychologist Forensic | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2010-04-27 |