| NPI | 1558708313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017691) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC-006965) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2014-10-20 |