| NPI | 1548604234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: PR 4650) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PR 004650) |
| 103T00000X Psychologist (Licence: PR 4650) | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2024-09-13 |