NPI | 1619135704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017167) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MI MI-6301012146) |
101YM0800X Counselor, Mental Health | |
103T00000X Psychologist | |
Enumeration Date | 2008-05-27 |
Last Update Date | 2020-10-21 |