| NPI | 1750710455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: UT 5184406-2501) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2022-09-15 |