| NPI | 1578511234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC000452) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PC000452) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-02-09 |