| NPI | 1255637633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 2648) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PR 2648) |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2015-01-22 |