| NPI | 1881314904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC018213) |
| Additional Taxonomies | 102L00000X Psychoanalyst |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2026-02-01 |