| NPI | 1710085105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016657L) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA LP004193) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS016657L) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-08-13 |