| NPI | 1215082987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3730) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-2223) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2024-07-26 |