| NPI | 1326313552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA PC004106) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC004106) |
| 101YP2500X Counselor, Professional (Licence: PA PC004106) | |
| 103TS0200X Psychologist, School (Licence: PA NCSP 32650) | |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2012-03-21 |