| NPI | 1407902745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: FL py0002702) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL py0002702) |
| 103TC1900X Psychologist, Counseling (Licence: FL py0002702) | |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2025-09-11 |