| NPI | 1295169381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3817) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 1857) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2020-12-11 |