| NPI | 1245362615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 3490) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 2778) |
| 103T00000X Psychologist | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2020-07-29 |