NPI | 1508035544 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8952) |
Additional Taxonomies | 101YP2500X Counselor, Professional |
103TC0700X Psychologist, Clinical (Licence: NY 024838) | |
Enumeration Date | 2008-02-25 |
Last Update Date | 2025-02-11 |