| NPI | 1518010636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: WY CSSP-18) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WY CSSP-18) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2024-01-14 |