| NPI | 1033623194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NV PY1030) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: OR 3473) |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2023-04-19 |