| NPI | 1710012844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 4708) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: SC 4708) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: SC 688) | |
| 103TS0200X Psychologist School (Licence: SC 688) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2011-03-24 |