| NPI | 1902812753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 686-125) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: WI K234000050327) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |