| NPI | 1346387065 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PA 27475946) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA 27475946) |
| 183500000X Pharmacist (Licence: PA 27475946) | |
| 207Q00000X Family Medicine (Licence: PA 27475946) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-07-08 |