| NPI | 1457404113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY12323) |
| 103T00000X Psychologist (Licence: FL PY12323) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2025-02-28 |