NPI | 1073861217 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY31294) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180008239) |
Enumeration Date | 2012-08-20 |
Last Update Date | 2024-04-26 |