| NPI | 1215169156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NV PY0849) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 9464) |
| 103T00000X Psychologist (Licence: NE 847) | |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2018-12-03 |