| NPI | 1053881839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC PRC15235) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: DC PRC15235) |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2023-07-19 |