| NPI | 1881320695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PR 6645) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PR 1094) |
| 103T00000X Psychologist (Licence: PR 6645) | |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2024-07-16 |