| NPI | 1770855785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS018394) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC005571) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2022-10-11 |