| NPI | 1033566088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: WI 3905-57) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 16670-130) |
| 101YP2500X Counselor, Professional (Licence: WI 3006-226) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2021-02-17 |