| NPI | 1174506505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SD 342) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: SD 342) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2022-09-01 |