| NPI | 1689779944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016423) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC003384) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2009-08-27 |