| NPI | 1053347971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 842) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NH 38) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2011-01-04 |