| NPI | 1255319307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017194) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA CW013140) |
| Enumeration Date | 2006-01-07 |
| Last Update Date | 2012-05-08 |