| NPI | 1477197929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: WI 3717-57) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: OR 3178) |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2022-12-29 |