| NPI | 1013244599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OR 2748) |
| 103TC1900X Psychologist Counseling | |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2021-01-08 |