| NPI | 1558555045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 2010006114) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2001031941) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2022-01-04 |