| NPI | 1205001971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS003268L) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PA PS003268L) |
| 106H00000X Marriage & Family Therapist (Licence: PA PS003268L) | |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-04-24 |