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 |