| NPI | 1932228756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA 1152) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: GA LMFT685) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |