| NPI | 1538931837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CT 3573157777) |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2023-12-23 |