| NPI | 1295244499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: LH60914024) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: WA MC60584631) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2020-03-06 |