| NPI | 1902347107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NM 256741) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: NM 256741) |
| 106H00000X Marriage & Family Therapist (Licence: NM 1009) | |
| 106H00000X Marriage & Family Therapist (Licence: VT 100.1025541) | |
| 103TS0200X Psychologist, School (Licence: VT 8058057) | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2017-04-07 |