| NPI | 1750453106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-004234) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LISAC11042) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2026-02-04 |