| NPI | 1154551505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: HI PSY1338) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL MH5487) |
| 103T00000X Psychologist (Licence: RI PS01312) | |
| 103T00000X Psychologist (Licence: FL PY11891) | |
| 103T00000X Psychologist (Licence: VA 0810007982) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2023-06-06 |