| NPI | 1689990350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NY 522615041) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: WA 405422g) |
| 103TC1900X Psychologist, Counseling (Licence: PR 1755) | |
| 103TS0200X Psychologist, School (Licence: WA 405422G) | |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2010-04-20 |