| NPI | 1134404916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005707) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0152691) |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2022-04-29 |