| NPI | 1619405826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: PR 5770) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: PR 5770) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2017-06-01 |