NPI | 1134510993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CO LPC.0012196) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0012196) |
Enumeration Date | 2015-02-13 |
Last Update Date | 2020-12-16 |