| NPI | 1700330651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5476) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 10947) |
| 101YM0800X Counselor Mental Health (Licence: NE 565) | |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2019-05-24 |