| NPI | 1912084682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: MA 6170) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 103TC1900X Psychologist, Counseling (Licence: MA 6170) | |
| 103T00000X Psychologist (Licence: MA 6170) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |