NPI | 1194036079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: NE 810) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 9118) |
Enumeration Date | 2010-06-25 |
Last Update Date | 2022-12-12 |