| NPI | 1336589472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 1443) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 6172) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2023-12-01 |