| NPI | 1689843658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 3901) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: AZ 3901) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-02-25 |