| NPI | 1023062528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 983) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 185) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2007-10-18 |