| NPI | 1902931132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 2973-57) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3865-125) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2018-03-17 |