| NPI | 1386606614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PA PS016724) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA pc004123) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2010-06-29 |