| NPI | 1043437908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016517) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 7050) |
| 103T00000X Psychologist (Licence: NY 016799) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PA PS016517) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS016517) | |
| 103TF0200X Psychologist, Forensic (Licence: PA PS016517) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2022-01-10 |