| NPI | 1245429745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC005016) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00129700) |
| 103T00000X Psychologist (Licence: PA PC005016) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PA PC005016) | |
| Enumeration Date | 2007-10-20 |
| Last Update Date | 2010-01-25 |