NPI | 1376861617 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004342) |
Enumeration Date | 2010-05-11 |
Last Update Date | 2018-03-27 |