| NPI | 1326473240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WI 3744-57) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 357-228) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2020-08-27 |