| NPI | 1841354768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA 01191) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA MFT000266) |
| 106H00000X Marriage & Family Therapist (Licence: PA MFT000266) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2020-11-10 |