| NPI | 1205233640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 1462) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10409) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2023-11-29 |