| NPI | 1346869385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL TPPY2904) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: HI MHC-653) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301019413) | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2025-01-07 |