| NPI | 1376845347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225400000X Rehabilitation Practitioner | |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2017-04-09 |