| NPI | 1194860593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NE 1068) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 3306) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2022-07-07 |