| NPI | 1033440466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY #535) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2010-01-25 |
| Last Update Date | 2015-05-07 |