| NPI | 1598340200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008255) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC PSYA00381) |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2023-08-21 |