| NPI | 1043407190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 1445) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 0128981) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2026-03-25 |