| NPI | 1619466505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MA 9061) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 9061) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2018-05-07 |