| NPI | 1588999536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY 9583) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ND HAR829785) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2016-07-12 |