| NPI | 1427850346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA 5894) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: 1234) |
| 103TS0200X Psychologist, School (Licence: 987456A) | |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-03-24 |