| NPI | 1235729575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 2020017925) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MO 2020017925) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2021-01-20 |