NPI | 1225347974 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: FL 8159) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA 32083) |
Enumeration Date | 2010-09-29 |
Last Update Date | 2025-09-18 |