| NPI | 1760780431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: FL SS 989) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL SS989) |
| Enumeration Date | 2011-03-04 |
| Last Update Date | 2020-04-01 |