| NPI | 1831389527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 2932) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 1625) |
| Enumeration Date | 2007-07-28 |
| Last Update Date | 2017-02-02 |