| NPI | 1558850008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS019638) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2024-01-10 |