| NPI | 1699110726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NC 4917) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 4917) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2024-03-28 |