| NPI | 1043444763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2009-05-08 |