| NPI | 1124574850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 1412) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: SC 1412) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2019-06-29 |