| NPI | 1407101835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NV PYT150330) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 9716) |
| 103T00000X Psychologist (Licence: NE 861) | |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2015-10-01 |