| NPI | 1942287602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NM 1020) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM 0088451) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH00008191) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2014-09-05 |