| NPI | 1215767645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-62248) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 210126021) |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2024-08-01 |