| NPI | 1689047730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 0006035) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 178.011414) |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2023-04-18 |