| NPI | 1336552033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 01759) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 0011661) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |