| NPI | 1588669386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 459) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 20) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2010-12-21 |