| NPI | 1336337583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-12792) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC-4744) |
| 103TF0200X Psychologist, Forensic (Licence: HI PSY-1275) | |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2015-07-08 |