| NPI | 1336472562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0139761) |
| Enumeration Date | 2009-09-04 |
| Last Update Date | 2017-09-05 |