| NPI | 1982623245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: PR 2432) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PR 2432) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-12-18 |