| NPI | 1104053461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 31990) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MO 01605) |
| 103TC1900X Psychologist, Counseling (Licence: KS 879) | |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2009-06-15 |