| NPI | 1093102188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: 48919) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2016-11-03 |