| NPI | 1689983496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PR 8581) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PR 10453) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2025-07-15 |