| NPI | 1104339043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PR 2620) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 3747) |
| 103T00000X Psychologist (Licence: PR 6419) | |
| 103TC0700X Psychologist, Clinical (Licence: PR 6419) | |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2020-07-30 |