| NPI | 1588786073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 1707) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 2640) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2024-07-11 |