| NPI | 1639365174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS016774) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103TC0700X Psychologist Clinical (Licence: NY 018246-1) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2016-07-15 |