| NPI | 1376064022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 1032) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10948) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2022-07-21 |