| NPI | 1679936876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PR 4149) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PR 4149) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2025-10-20 |