| NPI | 1487868899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2007028986) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 2007030433) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2020-12-28 |