| NPI | 1730700212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OR 3365) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 3365) |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2024-05-01 |