| NPI | 1962615252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: DE PC-0000439) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS-006161-L) |
| 103TC1900X Psychologist Counseling (Licence: PA PS-006161-L) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2018-08-01 |