NPI | 1033239827 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 295041-2504) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 295041-3501) |
Enumeration Date | 2007-03-29 |
Last Update Date | 2021-09-21 |