NPI | 1417253287 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: HI PSY-1521) |
Additional Taxonomies | 101YM0800X Counselor Mental Health |
Enumeration Date | 2011-01-26 |
Last Update Date | 2015-03-19 |