| NPI | 1376969642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MD 05610) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 003348) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2020-03-18 |