| NPI | 1447339783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL PY6509) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY6509) |
| 103TC0700X Psychologist Clinical (Licence: FL PY6509) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2019-04-04 |