| NPI | 1740712652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 0004665) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2022-09-21 |