| NPI | 1861697856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC004605) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC004605) |
| 101YM0800X Counselor Mental Health (Licence: PA PC004605) | |
| 106H00000X Marriage & Family Therapist (Licence: PA PC004605) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2016-12-07 |