| NPI | 1992705917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS-005959-L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS-005959-L) |
| 101Y00000X Counselor (Licence: PA PS-005959-L) | |
| 101YP1600X Counselor, Pastoral (Licence: PA PS005959-L) | |
| 101YM0800X Counselor, Mental Health (Licence: PA PS-005959-L) | |
| 101YP2500X Counselor, Professional (Licence: PA PS-005959-L) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS-005959-L) | |
| 103TC1900X Psychologist, Counseling (Licence: PA PS-005959-L) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS-005959-L) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: PA PS-005959-L) | |
| 305R00000X Preferred Provider Organization (Licence: PA PS-005959-L) | |
| 302R00000X Health Maintenance Organization (Licence: PA PS-005959-L) | |
| 305S00000X Point of Service (Licence: PA PS-005959-L) | |
| 302F00000X Exclusive Provider Organization (Licence: PA PS-005959-L) | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2007-11-23 |