| NPI | 1114235793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC2694) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MD 66723X6C1R5) |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2024-11-07 |