NPI | 1588786073 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: SC 1707) |
Additional Taxonomies | 101YP2500X Counselor Professional (Licence: SC 2640) |
Enumeration Date | 2007-04-04 |
Last Update Date | 2024-07-11 |