| NPI | 1194939967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NH 1302) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 630) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2014-01-29 |