| NPI | 1225347974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: FL 8159) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 32083) |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2025-09-18 |