| NPI | 1124443775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PR 4150) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2021-09-17 |