| NPI | 1538492152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PR 003109) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PR 001736) |
| 101YM0800X Counselor, Mental Health (Licence: PR 001736) | |
| 101YP2500X Counselor, Professional (Licence: PR 001736) | |
| 103TC1900X Psychologist, Counseling (Licence: PR 003109) | |
| 103TF0000X Psychologist, Family (Licence: PR 003109) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: PR 003109) | |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2010-02-19 |