NPI | 1376093476 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 4973) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10941) |
Enumeration Date | 2016-10-12 |
Last Update Date | 2023-01-23 |