| NPI | 1124527486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PR 5339) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PR 5339) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2022-07-14 |