| NPI | 1376015701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 5429-57) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 7205-125) |
| Enumeration Date | 2018-12-25 |
| Last Update Date | 2025-09-09 |