| NPI | 1699146761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC005150) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: PA MF000618p) |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2015-10-14 |