| NPI | 1720718463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 7390) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PR 7390) |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2022-06-15 |