| NPI | 1639387517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ND 3973) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NY 000211) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |