| NPI | 1700917341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL SS644) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 6436) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2025-09-11 |