| NPI | 1669525705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ 1618) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ 0012) |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2007-07-08 |