| NPI | 1346454345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS006754L) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: PA MF000036) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |