| NPI | 1609089655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 3829) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OK 1120) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2012-02-09 |