| NPI | 1801615356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MD 06719) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: VA 0810007344) |
| Enumeration Date | 2024-10-10 |
| Last Update Date | 2024-10-10 |