| NPI | 1407236300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3583-057) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 2517-226) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2024-06-28 |