| NPI | 1851520290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PR 3451) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: PR 3451) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2010-02-22 |