| NPI | 1891152195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS018777) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2019-05-29 |