| NPI | 1386657716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 4556) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 8283) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2007-07-08 |