| NPI | 1346307279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: WV 22028) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: WV 159) |
| 103TC1900X Psychologist, Counseling (Licence: MD 2202) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2025-09-11 |