| NPI | 1245066638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2024-09-11 |