| NPI | 1326193806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA ps005655L) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: PA MF000335) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2010-10-04 |