| NPI | 1235961319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: AL 2283) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA 34404) |
| Enumeration Date | 2024-08-16 |
| Last Update Date | 2024-08-16 |