| NPI | 1063483741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: SC 1323) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 004405) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2022-07-21 |