| NPI | 1922100684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 769) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WV 1287) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2008-08-06 |