| NPI | 1033765284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5756) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 5545) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2021-06-01 |