| NPI | 1669594693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016625) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.003490) |
| 106H00000X Marriage & Family Therapist (Licence: PA MF00569) | |
| 106H00000X Marriage & Family Therapist (Licence: IL 166.000678) | |
| 101YP2500X Counselor, Professional (Licence: IL 178002002) | |
| 106H00000X Marriage & Family Therapist (Licence: IL 166-000678) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2026-03-10 |