| NPI | 1568692721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103T00000X Psychologist | |
| 103TC1900X Psychologist, Counseling | |
| 103TE1100X Psychologist, Exercise & Sports | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2011-04-05 |