| NPI | 1790374502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PS007922L) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC000070) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PS007922) | |
| Enumeration Date | 2021-01-15 |
| Last Update Date | 2021-01-15 |