| NPI | 1376682351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MT 40432) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 341) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2025-09-11 |