| NPI | 1700660958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: ID 1171360) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ND 642) |
| 103T00000X Psychologist (Licence: ND 642P) | |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2025-09-23 |