| NPI | 1245942812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MA MA11533) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW016512) |
| 103TC1900X Psychologist, Counseling (Licence: RI PS01188) | |
| Enumeration Date | 2022-12-15 |
| Last Update Date | 2022-12-15 |