| NPI | 1730226838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016275) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC002311) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2020-02-07 |