| NPI | 1053773150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MA 10695) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: MA 10695) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2019-08-12 |