NPI | 1164130100 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 178.020406) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 101YM0800X) |
Enumeration Date | 2022-11-08 |
Last Update Date | 2024-07-31 |