| NPI | 1851591051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 01369) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 002357) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2007-10-27 |