| NPI | 1639508823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 3212-57) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 5020-125) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2019-07-09 |