| NPI | 1962497172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC10107) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ LPC10107) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2007-07-08 |