| NPI | 1457644478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WY 488) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY 1173) |
| 101YS0200X Counselor, School | |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2016-06-01 |