| NPI | 1093952814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: IL 180.008477) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 178.005814) |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2026-03-17 |