| NPI | 1235579889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3157) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MO 2010036636) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2022-07-01 |