| NPI | 1861883969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008735) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701010108) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2024-12-30 |