| NPI | 1326347261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: HI 1192) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: AZ 0442) |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2011-03-17 |