NPI | 1063863629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MS 641183) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180013378) |
Enumeration Date | 2016-06-24 |
Last Update Date | 2024-01-17 |