| NPI | 1578916615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 965) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10899) |
| 101YM0800X Counselor, Mental Health (Licence: NE 566) | |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2018-08-24 |