| NPI | 1942335260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 2163-057) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 2282-125) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2020-03-10 |