| NPI | 1477834133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38200) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA PSY25625) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2019-11-13 |