| NPI | 1013211333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 1486) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 2254) |
| Enumeration Date | 2010-12-29 |
| Last Update Date | 2010-12-29 |