| NPI | 1780898478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA 004492) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA 004492) |
| 106H00000X Marriage & Family Therapist (Licence: PA PC004492) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2021-06-08 |