| NPI | 1871030924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 003938) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 003120) |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2021-04-28 |