| NPI | 1679827356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OR C1066) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C1066) |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2012-11-02 |