| NPI | 1942408752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CT 003485) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: VA 0810003796) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2019-07-30 |