| NPI | 1700631785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 13038) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 071) |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-04-22 |