NPI | 1225301625 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NM 1520) |
Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: 1520) |
Enumeration Date | 2012-02-15 |
Last Update Date | 2018-07-12 |