| NPI | 1811906290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-15399) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PC003521) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2015-03-05 |