| NPI | 1366595878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7800) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH5170) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2010-09-15 |