| NPI | 1669506283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2008034858) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2004014038) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2014-09-10 |