| NPI | 1689013138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 05103) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MD 05103) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2021-12-01 |