| NPI | 1720156979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 1251) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 4251) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-08-21 |