| NPI | 1598844854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 1172) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2023-07-14 |