| NPI | 1841337268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39001471A) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL SS431) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2007-07-08 |