NPI | 1467512889 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1555) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2006-12-08 |
Last Update Date | 2022-08-05 |