| NPI | 1487672978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3109123) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 513125) |
| 106H00000X Marriage & Family Therapist (Licence: WI 176124) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-09-11 |