| NPI | 1588743538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MO 01892) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: KS 1022) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2008-11-05 |