| NPI | 1225375249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS018774) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC006651) |
| Enumeration Date | 2013-01-10 |
| Last Update Date | 2020-12-18 |