| NPI | 1508964784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: AZ 4041) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: UT 5653842-2501) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-12-15 |