| NPI | 1982219879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PA PS019276) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC012657) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2022-03-10 |