NPI | 1659866556 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008049) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2018-06-25 |
Last Update Date | 2023-08-24 |