| NPI | 1922110816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 1631) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WY 977) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-04-06 |