| NPI | 1093063539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-2872) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2022-05-27 |