| NPI | 1457012767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PA PS015452) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: DE B10000802) |
| Enumeration Date | 2022-01-08 |
| Last Update Date | 2022-01-08 |