| NPI | 1558583278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PA PS007269L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 1442) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2023-12-20 |