| NPI | 1861576712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MS 651227) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MS 0947) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2025-08-18 |