NPI | 1275185472 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO PSY.0006484) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 11915) |
Enumeration Date | 2019-07-09 |
Last Update Date | 2025-07-01 |