| NPI | 1700986957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: GA 1792) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: AL 731) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |