| NPI | 1033608898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 1374) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WV 979) |
| 103T00000X Psychologist (Licence: FL TPPY2991) | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2025-03-22 |