| NPI | 1760656664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: HI 843) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: HI 39) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2009-12-09 |