| NPI | 1184296881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OR 3755) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 026361) |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2026-03-19 |