NPI | 1639627763 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 5490) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
103TC0700X Psychologist, Clinical (Licence: TN 4064) | |
Enumeration Date | 2016-09-19 |
Last Update Date | 2024-08-29 |