| NPI | 1164428322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 00259) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MO 00259) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2007-10-31 |