| NPI | 1386737062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: AZ 3930) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: AL 1361) |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-11-03 |