| NPI | 1053729285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MS 61-1099) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MS 1767) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2021-11-11 |