| NPI | 1154342632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA PC002963) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PA PS-008920-L) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-08 |