| NPI | 1912214750 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017424) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC005567) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2013-08-15 |