| NPI | 1700304904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY004636) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC009754) |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2023-01-31 |