| NPI | 1811371446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 3460-57) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 5669-125) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2017-07-03 |