| NPI | 1184639882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NM 0180-P (DM9999)) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NM 233726) |
| 101YP2500X Counselor Professional (Licence: NM 0685) | |
| 101YM0800X Counselor Mental Health (Licence: NM 0685) | |
| 101Y00000X Counselor (Licence: NM 0685) | |
| 103T00000X Psychologist (Licence: NM 0180-P (DM9999)) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2007-07-09 |