| NPI | 1881837649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist Health |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MO 2007037811) |
| 103TC0700X Psychologist Clinical (Licence: MO 2010036623) | |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2024-01-02 |