| NPI | 1013154293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 4297) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0119031) |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2012-06-26 |