| NPI | 1609273176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 39063) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.009135) |
| 101YP2500X Counselor, Professional (Licence: TX 76320) | |
| Enumeration Date | 2014-11-29 |
| Last Update Date | 2024-06-26 |