| NPI | 1013089515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 10466) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA 6351) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2022-01-10 |