| NPI | 1477838399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: IA 078227) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: CT 002877) |
| 103TC1900X Psychologist Counseling (Licence: IA 078827) | |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2021-11-04 |