| NPI | 1609066562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS004144L) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC002006) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2007-07-26 |