| NPI | 1578692190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 1197) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 1197) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2008-01-25 |