| NPI | 1528339587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: WY 518) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 4712) |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2012-07-24 |