| NPI | 1295991578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 3156) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PR 3156) |
| 104100000X Social Worker (Licence: PR 8072) | |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2024-11-05 |