| NPI | 1164661666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CO 1900) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 1900) |
| Enumeration Date | 2009-02-07 |
| Last Update Date | 2009-02-07 |