| NPI | 1942416912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC S7714) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 7714) |
| 103TC1900X Psychologist, Counseling (Licence: NC 3335) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-10-22 |