| NPI | 1275553810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MS 22-272) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: MS 22-272) |
| 101YM0800X Counselor, Mental Health (Licence: MS 22-272) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-01-22 |