| NPI | 1225257272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID PSY-160) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID PSY-160) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2008-05-09 |