| NPI | 1821762220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MD 07251) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD A0611) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2025-03-07 |