| NPI | 1417239617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PR 3963) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PR 1046) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2015-05-12 |