| NPI | 1023281557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS016722) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC002136) |
| 103K00000X Behavior Analyst (Licence: PA 1-01-0675) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: PA PS016722) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PS016722) | |
| Enumeration Date | 2008-04-04 |
| Last Update Date | 2012-03-27 |