| NPI | 1134790488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 7212) |
| Additional Taxonomies | 104100000X Social Worker |
| 104100000X Social Worker (Licence: PR 2120) | |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2023-08-29 |