| NPI | 1063710952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: FL PY9374) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: KS LP03274) |
| 103TC1900X Psychologist, Counseling (Licence: CO PSY0003871) | |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2024-02-28 |