| NPI | 1447537766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA ps018603) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC006129) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2018-09-25 |