| NPI | 1306910880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 481) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY 974) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2022-07-26 |