| NPI | 1992814883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 3942) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC HSP-PA 1255) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-09 |