| NPI | 1841544681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2020008416) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103T00000X Psychologist (Licence: IA 076935) | |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2023-03-20 |