| NPI | 1528003142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 82171) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 1241) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2007-07-08 |