| 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 |