| NPI | 1215723663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS020619) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC017859) |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2026-01-30 |