| NPI | 1144349416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 3076) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 2575) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2021-11-21 |