| NPI | 1609895440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: WV 282) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: WV 22034) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2013-09-18 |