| NPI | 1215925169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PA 52183) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2018-11-07 |