| NPI | 1821229246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 817) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 3907) |
| 103T00000X Psychologist (Licence: NE 3907) | |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2021-05-17 |