| NPI | 1699027557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OK 1236) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MO 2012019765) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2015-07-31 |