NPI | 1619483112 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC010094) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC010094) |
106H00000X Marriage & Family Therapist (Licence: PA PC010094) | |
Enumeration Date | 2017-12-19 |
Last Update Date | 2018-03-17 |