| NPI | 1316022957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8756) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 4718) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2008-03-29 |