| NPI | 1649335399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AR P8103079) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AR 7819P) |
| Enumeration Date | 2006-12-23 |
| Last Update Date | 2007-07-08 |