| NPI | 1174586598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WY 33811) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: AZ 1098) |
| 103TC1900X Psychologist, Counseling (Licence: WY 172) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2007-07-09 |