| NPI | 1508933649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MO PY01267) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: KS 1305) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2010-07-30 |