| NPI | 1023240603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2327) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LPC-4593) |
| 101YP2500X Counselor, Professional (Licence: OR C2731) | |
| 103TC0700X Psychologist, Clinical (Licence: OR 2327) | |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2023-02-21 |