| NPI | 1265714133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OR 2967) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: WI 2738-57) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2019-10-23 |