| NPI | 1750381851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SD 353) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SD 1141) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2018-03-17 |