| NPI | 1174549075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID PSY-202138) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ID PSY-202138) |
| 106H00000X Marriage & Family Therapist (Licence: OR T0446) | |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT3042) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2010-12-27 |