| NPI | 1053510313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 259) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 217) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2007-07-16 |