| NPI | 1952519167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC012327) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 15233) |
| 101YM0800X Counselor, Mental Health | |
| 103TF0000X Psychologist, Family | |
| 106H00000X Marriage & Family Therapist (Licence: NJ 37AC00530000) | |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2021-10-12 |