| NPI | 1861444135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: PA PS004652L) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: TX 22679) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2007-07-08 |