| NPI | 1427527936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2018033466) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 002415) |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2018-11-14 |