| NPI | 1457434276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS005775L) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2018-01-18 |