NPI | 1154551505 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: HI PSY1338) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH5487) |
103T00000X Psychologist (Licence: RI PS01312) | |
103T00000X Psychologist (Licence: FL PY11891) | |
103T00000X Psychologist (Licence: VA 0810007982) | |
Enumeration Date | 2009-07-20 |
Last Update Date | 2023-06-06 |