| NPI | 1669593943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: PA 07607441) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC002855) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2025-09-11 |