| NPI | 1487125027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS019491) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC010787) |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2022-01-24 |