| NPI | 1346499555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4693) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MA 9558) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2022-09-25 |