| NPI | 1154519569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CO 3464) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 4642) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2012-02-27 |