| NPI | 1922306471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 1388) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WV 2126) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2026-01-28 |