| NPI | 1194036079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 810) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 9118) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2022-12-12 |