| NPI | 1396296968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY12541) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY12541) |
| 101Y00000X Counselor | |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2025-02-28 |