| NPI | 1447809777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 5112-57) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6301018026) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2023-10-14 |