| NPI | 1770864688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3405) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR 3588) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2022-09-03 |