NPI | 1598190076 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY11543) |
Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: CT 8.004015) |
Enumeration Date | 2013-09-04 |
Last Update Date | 2022-08-15 |