| NPI | 1679266027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 777) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 13392) |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2024-12-31 |