| NPI | 1518509421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 6446) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PR 9736) |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2019-10-11 |