| NPI | 1821280926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04445) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LCM132) |
| 106H00000X Marriage & Family Therapist (Licence: FL MFT2495) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2016-10-11 |