| NPI | 1295967222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 3400) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PR 000846) |
| Enumeration Date | 2009-08-08 |
| Last Update Date | 2009-08-08 |