| NPI | 1720238538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: VA 0810006445) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 1334) |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2024-02-07 |