NPI | 1376969642 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MD 05610) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CT 003348) |
Enumeration Date | 2014-03-11 |
Last Update Date | 2020-03-18 |