NPI | 1407020472 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301015335) |
Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC004819) |
103TC0700X Psychologist, Clinical (Licence: PA PS017237) | |
Enumeration Date | 2008-04-21 |
Last Update Date | 2017-03-17 |