| NPI | 1760656565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: TX 711980) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180003643) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2023-05-15 |