| NPI | 1366696700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00955) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: IA 00955) |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2025-08-15 |