| NPI | 1790858959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY9026) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 188) |
| 101YM0800X Counselor, Mental Health (Licence: NE 396) | |
| 103T00000X Psychologist (Licence: NE 620) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2019-02-13 |