| NPI | 1134607872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 6270) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PR 23940) |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2019-01-24 |