| NPI | 1497109987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TF0000X Psychologist, Family | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |