| NPI | 1770687212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC001541) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC001541) |
| 102L00000X Psychoanalyst | |
| 106H00000X Marriage & Family Therapist (Licence: PA PC001541) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2015-05-24 |