| NPI | 1033289863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 456) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 488) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2008-05-23 |