| NPI | 1316227192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TR0400X Psychologist Rehabilitation |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 4849) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2016-02-03 |