| NPI | 1922609072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TF0000X Psychologist, Family | |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2023-03-28 |