| NPI | 1942417829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2867) |
| Additional Taxonomies | 103TS0200X Psychologist School |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2023-09-29 |