| NPI | 1023123247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 4368) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 1642) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-08 |