| NPI | 1871663336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 01177) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-07-08 |