| NPI | 1396876843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 9882) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 7149) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2015-09-02 |