| NPI | 1871853721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CT 4226) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 2333) |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2022-05-25 |