| NPI | 1750351409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2006034106) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2002023735) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2013-09-18 |