| NPI | 1073623062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00226600) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC002162) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS008527L) | |
| 103TC0700X Psychologist, Clinical (Licence: IN 20040606) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |