| NPI | 1790285377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008334) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC012077) |
| 101YP2500X Counselor, Professional (Licence: VA 0701011884) | |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2023-11-09 |