NPI | 1619920980 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 0575) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 1973) |
101YM0800X Counselor, Mental Health (Licence: SC 0575) | |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: SC 0575) | |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 1973) | |
103TC0700X Psychologist, Clinical (Licence: NC 1973) | |
103T00000X Psychologist (Licence: SC 0575) | |
103T00000X Psychologist (Licence: NC 1973) | |
Enumeration Date | 2006-05-18 |
Last Update Date | 2010-09-02 |