| NPI | 1154334605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: PR 993) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL MH6051) |
| 101YM0800X Counselor Mental Health (Licence: NY 001578) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2008-06-19 |