| NPI | 1104841329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 1794) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 1794) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2024-07-15 |