| NPI | 1578868816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: PA SW128930) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: PA SW12893) | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2023-09-09 |