| NPI | 1750436457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 9422) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YS0200X Counselor, School | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2011-09-28 |