| NPI | 1689998221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO 2011032573) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MO 2010007876) |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2025-07-21 |