| NPI | 1073552600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 3187) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 2291) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-07-08 |