| NPI | 1154675668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: 2423) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: 2423) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2015-11-13 |