| NPI | 1033467279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 6117) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PR 4218) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2018-07-16 |