| NPI | 1689748832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1366) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 917) |
| 103TS0200X Psychologist, School (Licence: NE 2005004217) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2008-01-22 |