| NPI | 1477858785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: ID PSY-203023) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID 5800) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2022-07-06 |