| NPI | 1548428279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS002415-L) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PS002415-L) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2008-05-29 |