| NPI | 1437186913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MO 2003023863) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: KS 1359) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2022-11-14 |