| NPI | 1447400478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 1778) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 64164) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2019-03-06 |