NPI | 1043082142 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PR 7063) |
Additional Taxonomies | 103T00000X Psychologist (Licence: PR 7063) |
Enumeration Date | 2023-10-23 |
Last Update Date | 2025-05-12 |