| NPI | 1336551464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YS0200X Counselor, School |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2014-05-23 |