| NPI | 1376637538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: GA 3078) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 1413) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2016-09-07 |