| NPI | 1659808574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AK 110271) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AK 110271) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2017-05-23 |