| NPI | 1467839639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TR0400X Psychologist, Rehabilitation (Licence: PA pa005058L) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 103TC1900X Psychologist, Counseling (Licence: PA ps005058L) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA ps005058L) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103T00000X Psychologist (Licence: PA ps005058L) | |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2015-04-30 |