| NPI | 1588639033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: SD 316) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: SD 316) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2012-03-29 |