| NPI | 1750453106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY004234) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LISAC11042) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2021-07-23 |