| NPI | 1033205125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2006033324) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2019-04-29 |