| NPI | 1841400132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging |
| 103TH0100X Psychologist Health Service | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |