NPI | 1225470156 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3076) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2013-07-19 |
Last Update Date | 2022-11-08 |