| NPI | 1922112671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MS 36-603) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: LA 881) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2013-01-11 |