| NPI | 1407985716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 1147) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CT 593) |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2010-12-14 |