| NPI | 1568602399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NM 1072) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 23088) |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2018-05-17 |