| NPI | 1245440684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 103T00000X Psychologist | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2013-06-03 |