| NPI | 1881711026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NC 1094) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 411) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2013-10-17 |