| NPI | 1740355288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003603) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC005028) |
| 103TC1900X Psychologist, Counseling (Licence: GA PSY003603) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2012-09-18 |