| NPI | 1821137159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2016035928) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2010024663) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2017-10-16 |