| NPI | 1740775667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2018-06-22 |