| NPI | 1144012071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6362010161) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2025-05-19 |
| Last Update Date | 2026-04-09 |