| NPI | 1235361619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AL 1704) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling |
| 103TC1900X Psychologist Counseling (Licence: AL 1704) | |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2022-03-10 |