| NPI | 1538581905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3233) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC006701) |
| Enumeration Date | 2014-01-20 |
| Last Update Date | 2022-03-21 |