| NPI | 1689089229 |
|---|---|
| Former Name | MICHELLE GLICKMAN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS019712) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC011819) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2024-08-16 |