| NPI | 1164685582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 297957) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 3089125) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2011-12-28 |