| NPI | 1679592448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 001686) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL PY7545) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2015-03-30 |