| NPI | 1215056809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003899) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA D6540235) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2018-03-17 |