| NPI | 1679391858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 3280) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PR 3280) |
| Enumeration Date | 2024-09-27 |
| Last Update Date | 2025-01-17 |