| NPI | 1215984448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS002134L) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PS002134L) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2025-03-14 |