| NPI | 1326358201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: CO PSY.0005685) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 8613) |
| 101YP2500X Counselor Professional (Licence: OH E.0600653) | |
| 103TC1900X Psychologist Counseling (Licence: MA 11223) | |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2024-05-14 |