| NPI | 1740348002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 4448) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 196) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |