| NPI | 1003348228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MA 10765) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2025-04-15 |