| NPI | 1861443921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: GA PSY001194) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NC 1399) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2007-07-08 |