| NPI | 1609881002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SD 512) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 4080) |
| 103TC1900X Psychologist, Counseling (Licence: WA PY 60187443) | |
| 103T00000X Psychologist (Licence: CO 3444) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2013-09-17 |