| NPI | 1861814428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: IA 01000) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: IA 01000) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2014-01-15 |