| NPI | 1952428468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 665) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 10473) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-07-08 |