| NPI | 1932693058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 6141) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PR 6141) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2026-01-02 |