| NPI | 1235233511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC004645) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA 02261) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2007-07-13 |