| NPI | 1528312733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TE1100X Psychologist, Exercise & Sports | |
| 103TF0000X Psychologist, Family | |
| 103TH0100X Psychologist, Health Service | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 106H00000X Marriage & Family Therapist | |
| 172A00000X Driver | |
| Enumeration Date | 2012-11-09 |
| Last Update Date | 2012-11-09 |