| NPI | 1013505858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: GA PSY004541) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2023-04-03 |