NPI | 1407955818 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: WI 147357) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 61124) |
106H00000X Marriage & Family Therapist (Licence: IL 166000461) | |
Enumeration Date | 2006-09-22 |
Last Update Date | 2021-10-14 |