| NPI | 1164586673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2007-07-08 |