NPI | 1144427196 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0701005950) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 6644) |
101YM0800X Counselor, Mental Health (Licence: VA 0701005950) | |
Enumeration Date | 2007-07-02 |
Last Update Date | 2023-02-07 |