| NPI | 1265468771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 2776) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 1845) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2013-07-31 |