| NPI | 1376093476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 4973) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10941) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2023-01-23 |