| NPI | 1285961664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2009-11-05 |