| NPI | 1972645695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NM 0079181) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: NM 271997) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-08 |