| NPI | 1922712496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: FL SS598) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH1859) |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2023-01-10 |