| NPI | 1316010077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA 001332) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA 000252) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2010-07-19 |