| NPI | 1316022338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 1297) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 000575) |
| 103TC1900X Psychologist, Counseling (Licence: MO R0443) | |
| 106H00000X Marriage & Family Therapist (Licence: MO 300007) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2012-11-05 |