| NPI | 1114034667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 2718-057) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 3600-125) |
| 101Y00000X Counselor (Licence: IL 178-002408) | |
| 103TH0004X Psychologist, Health (Licence: WI 2718) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2021-11-19 |