| NPI | 1811794092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MD 5894) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: 987456A) |
| 103TF0000X Psychologist, Family (Licence: MD 1234) | |
| Enumeration Date | 2025-02-26 |
| Last Update Date | 2025-02-26 |