| NPI | 1891829438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 2561) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 73) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |