| NPI | 1003914797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NE 768) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 00812) |
| 101YM0800X Counselor, Mental Health (Licence: NE 589) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-01-21 |