| NPI | 1043496631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 3056) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PR 4269680) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2024-08-25 |