| NPI | 1538138375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101Y00000X Counselor (Licence: 61290) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MO 2000152363) |
| 103T00000X Psychologist (Licence: 01194) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2007-07-08 |