| NPI | 1487632816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PS004674L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS004674) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2019-05-10 |