| NPI | 1619041035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: DE B1-595) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PA PS003893-L) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2007-07-08 |