NPI | 1497873012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016410) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC001660) |
Enumeration Date | 2007-03-26 |
Last Update Date | 2012-03-26 |