| NPI | 1780892844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| 103T00000X Psychologist | |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2010-09-07 |