| NPI | 1932563673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ PSY-005572) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO PSY.0005360) |
| 101Y00000X Counselor | |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2023-08-17 |