| NPI | 1831305804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA PC001040) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS002232L) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |