| NPI | 1174129530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1744R1102X Specialist, Research Study |
| 261QR1100X Clinic/Center, Research | |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2020-12-09 |