| NPI | 1417102419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS006539L) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC2705) |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2008-11-19 |