| NPI | 1891176889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS018295) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC007568) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2025-04-11 |