| NPI | 1275531329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016807) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA PC003548) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2010-11-24 |