| NPI | 1902818107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MA 6281) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 22) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2016-06-28 |