| NPI | 1003886656 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016996) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC001895) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2015-01-07 |