| NPI | 1366426819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YP1600X Counselor Pastoral |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NC 1746) |
| 103TC0700X Psychologist Clinical (Licence: NC 1746) | |
| 103TC1900X Psychologist Counseling (Licence: NC 1746) | |
| 103T00000X Psychologist (Licence: NC 1746) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2022-07-21 |