| NPI | 1124181276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM T0096581) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM T0096581) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-08 |