| NPI | 1306132436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2023-11-14 |