| NPI | 1144427196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0701005950) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 6644) |
| 101YM0800X Counselor, Mental Health (Licence: VA 0701005950) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2023-02-07 |