| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 103TA0700X Psychologist, Adult Development & Aging |
| 103TC1900X Psychologist, Counseling |
| 103TE1100X Psychologist, Exercise & Sports |
| 103TF0000X Psychologist, Family |
| 103TF0200X Psychologist, Forensic |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| 103TP0814X Psychologist, Psychoanalysis |
| 103TP2701X Psychologist, Group Psychotherapy |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2016-08-29 |