| NPI | 1699912337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ID LPC-4174) |
| Additional Taxonomies | 103TS0200X Psychologist School |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2009-01-16 |