| NPI | 1861542060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PR 1713) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 001713) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2024-11-21 |