| NPI | 1609956374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TN 1306) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: GA 1035) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2015-04-29 |