| NPI | 1447434972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 275501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC PRC14203) |
| 101YM0800X Counselor, Mental Health (Licence: TN 2334) | |
| 103TC0700X Psychologist, Clinical (Licence: IN 99081736A) | |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2022-02-28 |