| NPI | 1235499773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 1421) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 5124) |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2023-04-24 |