| NPI | 1417379405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PR 005172) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PR 004195) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2025-08-25 |