| NPI | 1689715872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 5447) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC001309) |
| 103T00000X Psychologist (Licence: GA PSY002188) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2010-08-27 |