| NPI | 1225301625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NM 1520) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: 1520) |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2018-07-12 |