| NPI | 1932253937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 1159) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 1159) |
| 103TC1900X Psychologist, Counseling (Licence: NC 1159) | |
| 103TF0000X Psychologist, Family (Licence: NC 1159) | |
| 103T00000X Psychologist (Licence: NC 1159) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 1159) | |
| 106H00000X Marriage & Family Therapist (Licence: NC 1159) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |