| NPI | 1982656831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NV PY0692) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH5282) |
| 103T00000X Psychologist (Licence: PA PS04738-L) | |
| 103T00000X Psychologist (Licence: CA PSY22181) | |
| 103T00000X Psychologist (Licence: GA PSY003253) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2018-08-17 |