| NPI | 1275696817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA MD013696E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD013696E) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2009-03-19 |