| NPI | 1467783498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2010-01-14 |
| Last Update Date | 2010-01-14 |