| NPI | 1689719791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 1437) |
| 103TC0700X Psychologist, Clinical (Licence: DC PSY1000703) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2025-03-31 |