| NPI | 1447536792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4413) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NC 4413) |
| 251S00000X (Licence: NC 4413) | |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2017-08-14 |