| NPI | 1154428274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO PY00785) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 1279) |
| 106H00000X Marriage & Family Therapist (Licence: MO 300032) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-11-23 |