| NPI | 1568542926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC001822) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG000049) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-08 |