| NPI | 1982869111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: VT 048.0058348) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 004067) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2015-03-23 |