NPI | 1336546035 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3476) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2014-11-24 |
Last Update Date | 2022-07-18 |