| NPI | 1093793952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC 916) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 405) |
| Enumeration Date | 2006-01-02 |
| Last Update Date | 2025-09-11 |