NPI | 1285611145 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10218) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 5820) |
Enumeration Date | 2005-12-30 |
Last Update Date | 2015-10-09 |