| NPI | 1275270555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 287242) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 240559) |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2023-11-15 |