| NPI | 1598093221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WI 3273-57) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 4311-125) |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2015-08-27 |