| NPI | 1235161373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 2736057) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3643125) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2008-09-12 |