| NPI | 1407282387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PR 3680) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PR 3680) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2016-06-10 |