| NPI | 1821153099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016458) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC000106) |
| 103TC1900X Psychologist, Counseling (Licence: PA PS016458) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2010-12-20 |