| NPI | 1801832878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 3703) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CO 0003703) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2016-04-26 |