| NPI | 1124182548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN 2285) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TN 1016) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2023-05-23 |