| NPI | 1497902555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3070-057) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 1824-121) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2021-12-01 |