| NPI | 1750566998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 5903) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2012-08-15 |