| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TR0400X Psychologist Rehabilitation |
| 103TH0100X Psychologist Health Service |
| 106H00000X Marriage & Family Therapist |
| 103T00000X Psychologist |
| 103TA0700X Psychologist Adult Development & Aging |
| 103TC1900X Psychologist Counseling |
| 103TF0000X Psychologist Family |
| 103TF0200X Psychologist Forensic |
| 103TP2701X Psychologist Group Psychotherapy |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2007-07-08 |