| NPI | 1023104262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OK 1091) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OK 3091LPC) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2009-08-26 |