| NPI | 1306299177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: FL PY11165) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TE1100X Psychologist, Exercise & Sports (Licence: FL PY11165) | |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2023-03-03 |