| NPI | 1699353490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NC A16384) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A16384) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2022-02-03 |