| NPI | 1891976254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 01240) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 103TF0000X Psychologist, Family | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2007-11-14 |