| NPI | 1144773011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NC 4927) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2011009699) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2016-07-27 |