| NPI | 1285734764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NM 1538) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT 619) |
| 103T00000X Psychologist (Licence: MT 313) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2019-04-25 |