| NPI | 1831125673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY 7932) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 002882) |
| 101YM0800X Counselor Mental Health (Licence: FL MT000597) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2009-06-04 |