| NPI | 1730317082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PR 3458) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: PR 3458) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2019-11-22 |