| NPI | 1023676350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 982) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 5115) |
| 225X00000X Occupational Therapist (Licence: LA 3114099) | |
| 235Z00000X Speech-Language Pathologist, (Licence: LA 8246) | |
| Enumeration Date | 2019-06-01 |
| Last Update Date | 2019-06-01 |