| NPI | 1215158852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 1193) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: HI 111) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-05-26 |