| NPI | 1356369375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 0178) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 0178) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-03-25 |