| NPI | 1124216346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY7835) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL PY7835) |
| 101YM0800X Counselor, Mental Health (Licence: FL PY7835) | |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2024-08-23 |