| NPI | 1215017694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MD 1003) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL PY4750) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2024-06-01 |