| NPI | 1821612490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA MF001493) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: PA MF001493) | |
| Enumeration Date | 2020-05-30 |
| Last Update Date | 2025-02-18 |