NPI | 1306194048 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 0004545) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2012-08-28 |
Last Update Date | 2020-07-30 |