| NPI | 1568835049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 2809) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2023-03-07 |