| NPI | 1619612934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy |
| Additional Taxonomies | 101Y00000X Counselor (Licence: DC LC50078067) |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2023-12-21 |