NPI | 1083163125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS019749) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2016-09-30 |
Last Update Date | 2025-04-25 |