NPI | 1215767645 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-62248) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 210126021) |
Enumeration Date | 2024-08-01 |
Last Update Date | 2024-08-01 |