| NPI | 1366756512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC NC 2274) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 2274) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2021-08-30 |