| NPI | 1831382837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO PSY.0001995) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 1995) |
| 101YM0800X Counselor Mental Health (Licence: CO 1995) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2021-02-18 |