| NPI | 1225115561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WY 437) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WY 437) |
| 103TC1900X Psychologist Counseling (Licence: WY 437) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2022-05-09 |