| NPI | 1346770666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NC c010704) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL sw11255) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2021-05-10 |