| NPI | 1912063330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 001361) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2025-09-11 |