| NPI | 1073655361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 06999) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 06999) |
| 106H00000X Marriage & Family Therapist (Licence: MD 06999) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |