| NPI | 1003100439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: WI 1348) |
| Additional Taxonomies | 103TF0000X Psychologist Family (Licence: GA 3450) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2011-06-02 |