NPI | 1295196152 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TH0100X Psychologist, Health Service |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401014593) |
103TH0100X Psychologist, Health Service (Licence: LA 1544) | |
Enumeration Date | 2016-03-18 |
Last Update Date | 2022-09-27 |