| NPI | 1134782055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2023038407) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 78181) |
| 101YP2500X Counselor, Professional (Licence: MO 2023036667) | |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2023-12-14 |