| NPI | 1053484410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016398) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC002468) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2024-04-01 |